Healthcare Provider Details

I. General information

NPI: 1881312536
Provider Name (Legal Business Name): LILI MICAELA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38954 PROCTOR BLVD # 147
SANDY OR
97055-8039
US

IV. Provider business mailing address

38954 PROCTOR BLVD # 147
SANDY OR
97055-8039
US

V. Phone/Fax

Practice location:
  • Phone: 503-922-6307
  • Fax:
Mailing address:
  • Phone: 503-922-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: